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Flashcards in Headache Deck (60)
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1

what is the exam usually like in headache

normal
expect in tumours

2

name the ha:
visual disturbance, sub acute onset headache, dark rooms make it better

migraine

3

name the ha:
Headache every time you stood up and fine when you sat down

low ICP

4

name the ha:
Every time you lie down heachache and when stand up fine, wakes you up in morning

high ICP

5

name the ha:
Make, smoker, one sided headache v sore that lasts half an hour

cluster ha

6

name the ha:
non specific, pain 2 on scale

stress ha

7

what are the associated factors you should ask about

Autonomic features (N+V), photophobia, phonophobia, positive visual symptoms, ptosis, miosis, nasal stuffiness

8

what are the ha exacerbating factor you should ask about

Posture, valsalva (sneezing, coughing, straining etc). Diurnal variation.

9

who does a migraine most commonly affect

young females

worse in teenage years/ early 20s then worse again in 40s/50s

10

what are the red flags for headaches

new onset >55
known/ previous malignancy
immunosuppressed (worry about intracranial infection)
early morning ha
exacerbated by valsalva (coughing, sneezing= raised ICP)

11

what past medical history is important in has

previous cancer
predisposition to thrombosis

12

why is social history important in ha

as problems can manifest as pain

13

how often do people usually get migrinaes

once a month

14

what are the diagnostic (IHS criteria) features for a migraine without aura

at least 5 attacks
lasts 4-72 hours

2 of:
-moderate/ severe, unilateral, throbbing pain, worse on movement

1 of:
-autonomic features, photo/phono phobia

15

when is migraine pain worse

evolves from on set, not worse at start
reaches 6/7 out of 10 pain

16

what is the pathophysiology of a migraine

both vascular and neural influences
have to be susceptible patient
stress trigger changes in brain- release of serotonin
blood vessels constrict and dilate
chemical including substance P irritate nerves and blood vessels causing pain

17

what is the pathophysiology of a migraine with aura

-cortical spreading depolarisation
-activation trigeminal vascular system - dilation of cranial blood vessels
-release of substance P, neurokinin A, CGRP

18

where is the migraine centre

dorsal raphe nucleus and the locus coeruleus

19

how many migraines have an aura

20%

20

what is an 'aura'

fully reversible visual, sensory, motor or language symtoms

visual most common

21

what language symptoms can you get with migraine

speech problems
word finding difficulties

22

how long does an aura usually last

20-60 mins, headache follows < 1 hour later (but can occur simultaneously)

23

what types of visual aura can you get

central scotomata
central fortification
hemianopic loss

24

what are the migraine tiggers

sleep
dietary (chocolate, cheese, alcohol)
stress
hormonal (menstrual)
physical exertion

(ha diary helpful to identify)

25

what are the non pharmological treatments for migraines

education- avoid triggers
ha diary
relaxation/ stress management
healthy diet
hydration
reduce caffeine
exercise

26

what are the acute/ abortive pharmalogical treatments for migraines

NSAID:
-aspirin 900mg,
-naproxen 250mg,
-ibruprofen
+/- anti emetic if gastroparesis
take asap

Triptans
-5HT agonist (Rizatriptan= eletriptan > sumatriptan)
Oral, sub-lingual, subcutaneous- consider method of administration in those with N+V
treat at start of headache
similar efficacy to NSAIDS

27

what are the prophylaxic treatments for migraines

amitriptyline (10-25mg)
propanalol (80-240mg)
topiramate (25-100mg)

titrate drug as tolerated to achieve efficacy at the lowest dose possible
Must trial each for minimum of 3 months
Consider non-pharmacological methods such as acupuncture, relaxation exercises

others inc- gabapentin, pizotifen, Na valporate, botox (given if 3 failed medicines), monoclonal antibodies

28

when do you gove migraine prophylaxs

3 attacks per month or if very severe

29

what are the side effecrts of amitriptyline

dry mouth
postural hypotension
sedation
light headedness

30

who do you not give a beta blocker to

asthmatics, PVD, heart failure